Pain when swallowing in neck and back- lump in throat

I would just like to say that these symptoms started for me 9 mounths ago I am still unsure what it is. All I can say is keep going back to GP as it gets so uncomfortable, it does get you down. Keep smiling regards

I had the same issue and had endoscopy. I had inflamed esophogus due to taking fosamax. Watch out for meds that say take with plenty of water!!

I am seeing that many are having issues with throat lump and back pain.  Let me demystify the symptoms.

Luke,

did you feel any sharp pain around ur neck and below your shoulder blade? because i'm getting those on the right side. my laryngoscopy report is normal and the ENT is saying that it's all in my head which, i strongly believe, isn't the case. your reply will be really appreciated as i'm freaking out.

Sam

MasterDoc,



I'm 24 and 3 years ago i choked on a food, accidentally swallowed a plum seed with a click sound on the way down. Immediate X-rays showed the throat was normal. But the lodged globus feeling is still there to this day to the right side of my vocal chord. Since that day's fiasco, I had been having pharyngitis once every year. The tendency of swallowing twice and even thrice was always there, where I'd feel that the lump's moving. The ENT was insistent that it was all in my mind and it drove me nuts because i could swear something was there. Strangely, 2 weeks ago i got his weird fever which didn't show any flu-like symptoms, such as cold, or coughs, but a mild pharyngitis. So the ENT, thankfully, made me do a Laryngoscopy, a TSH and CBC test, and an ultra sonogram of my entire throat. The reports came normal again. However, two days later i found out that I am infected with Hepatitis-a and hence the fever. The ENT diagnosis was stalled hence.



But now with the routine resting period, i have got too much time to ponder over my throat discomfort for my liking, and the lump feeling has grown on me. The throat's mostly never felt relaxed over the last three years, apart from a few times where for a very very brief moment the lump dissappeared. It's gets worse as the day progresses, and gets me freaked out at night.

The glands under my chin are giving me occassional sharp pains and also behind my right ear. There's also some pain behind my right hyoid bone. Furthermore, at times, my neck above the right shoulder blade, closer to the spine,

gives off a pinchy throbs. I stopped smoking about a month ago in the hopes of making it go away. But my throat feels really irritated right now and i need to know what's causing this. Meawhile, I at times wake up from sleep with a dead arm and I do have a little bit of anxiety, I mean come on... it's only natural.



I've told you everything because I don't want to leave out any details should they prove to be important knowledge.



Could be because my vocal cord nerves got damaged when i choked?

Or do i have an ear infection as well as an anxiety related spasm?

Or is it much more serious than that?



would really appreciate your reply.



Sam

wow---docmaster....great info!

sam_bro wrote:

DocMaster wrote:

I am seeing that many are having issues with throat lump and back pain.  Let me demystify the symptoms.

The throat is nothing more than two tubes: the trachea which is the windpipe, the part that you can feel.  It has cartilage and is ringlike.  Behind that, is the esophagus, also known as the tube that allows food to pass into your stomach.  Behind that is your spinal cord (cervical).  Surrounding all of these are muscles and lastly, skin.  there are nerve fibers running within the muscles.  prominent ones can include nerves 10 (vagus) which controls heart rate, nerve 7 (controls motor function to the face/tongue and sensation to the tongue), nerve 11 (muscles for swallowing in the esophagus).  Nerve 11 also controls your shoulders and muscles that aid in raising or lowering your wing bones. 

Now let's get back to the throat lump.  There are several causes to the throat lump:

1. physiological - this part deals with nerves

2. mechanical - this part deals with muscles and anything else that causes obstruction

In the context of throat lump, one has to be specific:

1. Timing when it occurs.  If it comes and goes --> unlikely to be cancer.  If it stays, one has to ask, what are my risk factors???  Do you smoke, drink, oral sex (there is increasing evidence in head/neck cancer related to HPV).  HPV usually appears behind the tongue.  HPV is the same virus that causes warts.

2. symptoms.  does it cause pain?  does it cause hoarseness?  This means that the lump impinged on surrounding structures

3. Associations.  Does heat make it better?  Does ibuprofen, motrin or any other NSAIDs improve it??  This point towards inflammation.  Warm gargles with salt will improve inflammation because heat mobilizes the lump and the salt draws water out of the lump.  

4. Red flag symptoms: weight loss, pain with swallowing, vomiting of blood, going number 2 with blood.  These are worrisome signs and require further workup with endoscopy.

Causes:

1. acid reflux can cause many symptoms.  risk factors are: obesity, caffeine, chocolate, smoking, alcoholic, eating too much before bedtime.  Symptoms can include heartburn, chronic cough, hoarseness, asthma.  This is due to the inadequate closure of the lower esophageal sphincter that normally prevents acid from refluxing into the esophagus.  Thus when lying down, it refluxes into the throat.  If the reflux is high enough, it can cause reflux into the larynx (voice box) called Laryngopharyngeal reflux.  This can result in a throat lump sensation with hoarseness.  Chronic reflux can cause scarring and also cause a throat lump.  Treatment is anti-reflux therapy, weight loss, quit alcohol, eat small meals.

2. cricopharyngeal spasm: cause is not known but this is due to the muscles surrouding the adam's apple to constrict causing a choking sensation associated with nausea, and difficulty swallowing.  Although no real problems with eating or drinking.  This will go away...eventually.

3. Accessory nerve impingement: nerve 11 courses down the throat into the back to the wing  bone.  Impingment of this nerve will cause a throat lump with back pain.  Risk factors are trauma, stress, lifting objects, stiff neck.  There is usually a knot near the wing bone that is extremely painful on massage.  But massaging it will relieve the throat lump as well as the back pain.

4. Allergies: can cause lymph nodes to enlarge.  The lymph nodes are located on the sides of the esophagus.  When enlarged, can impinge and cause a throat lump.  Enlargement causes include: allergies, infections, cancer.

5. Bony disease: arthritis of the spine can cause a throat lump since the spine sits behind the esophagus.  Also misalignment of bones can cause the same.

6.  Infections: middle ear infections, throat infections, esophageal infection/inflammation can cause lymph node enlargements and thus throat lump.  you can get fevers here.

Workup:

the workup of throat lump, if symptomatic (causing swallowing difficulties), being with a swallow study called barium swallow.  here you swallow food with a tracer and multiple x rays are taken to see if there is mechanical obstruction.

If there is a mechanical obstruction, the next test is a EGD where a camera is placed into the throat to see what it is.  

If there is no mechanical obstruction, the next test is a manometry where electrodes are placed to check for nerve function.

Imaging studies are also good.  CT scans are very good.  MRI even better but much more costly.

Rx:

if due to acid reflux, try anti-reflux therapy

if due to infection, check for Strep throat, Infectious Mono - Dr will do a throat swab and start abx.

Allergies: antihistamine

If symptoms do not improve, seek professional care.

Again these are for educational purposes only.  I do not diagnose any disease or infer based on unfound physical examinations.

MasterDoc,

I'm 24 and 3 years ago i choked on a food, accidentally swallowed a plum seed with a click sound on the way down. Immediate X-rays showed the throat was normal. But the lodged globus feeling is still there to this day to the right side of my vocal chord. Since that day's fiasco, I had been having pharyngitis once every year. The tendency of swallowing twice and even thrice was always there, where I'd feel that the lump's moving. The ENT was insistent that it was all in my mind and it drove me nuts because i could swear something was there. Strangely, 2 weeks ago i got his weird fever which didn't show any flu-like symptoms, such as cold, or coughs, but a mild pharyngitis. So the ENT, thankfully, made me do a Laryngoscopy, a TSH and CBC test, and an ultra sonogram of my entire throat. The reports came normal again. However, two days later i found out that I am infected with Hepatitis-a and hence the fever. The ENT diagnosis was stalled hence.

But now with the routine resting period, i have got too much time to ponder over my throat discomfort for my liking, and the lump feeling has grown on me. The throat's mostly never felt relaxed over the last three years, apart from a few times where for a very very brief moment the lump dissappeared. It's gets worse as the day progresses, and gets me freaked out at night.
The glands under my chin are giving me occassional sharp pains and also behind my right ear. There's also some pain behind my right hyoid bone. Furthermore, at times, my neck above the right shoulder blade, closer to the spine,
gives off a pinchy throbs. I stopped smoking about a month ago in the hopes of making it go away. But my throat feels really irritated right now and i need to know what's causing this. Meawhile, I at times wake up from sleep with a dead arm and I do have a little bit of anxiety, I mean come on... it's only natural.

I've told you everything because I don't want to leave out any details should they prove to be important knowledge.

Could be because my vocal cord nerves got damaged when i choked?
Or do i have an ear infection as well as an anxiety related spasm?
Or is it much more serious than that?

would really appreciate your reply.

Sam

Hi Sam,

Throat lumps can be very tricky. May I ask how long you have smoked and much you have smoked? Are you engaged in any high risk oral sexual behaviors? Are you losing weight? Does the throat lump cause pain with swallowing?

What I am trying to understand is the red flag symptoms to throat lump which includes:

1. age > 55 y.o
2. unintentional weight loss
3. pain with swallowing
4. blood in the stool
5. spitting up of blood
etc ... etc...

These red flags are indicative of cancers although further testings are necessary.

Given your presentation, I highly doubt that vocal cords are damaged as can be seen from a laryngoscopy. If you have no problems talking, chances are your vocal cords are intact.

With the ear presentation, is there ear fullness behind the ear? Do you feel pressure? Ear infections can precipitate pharyngitis. The ear has a drainage tube called the Eustachian tube which acts to drain all the junk stuff from the middle ear. When it is clogged, bacteria builds up and cause a middle ear infection which can be present as: ear fullness, pressure, diminished hearing, pain and sometimes discharge, dizziness, ringing in the ear. To diagnose an ear infection, your ENT would need to look into your ear with an otoscope. The treatment is empiric. Middle ear infections are usually caused by the same organisms that cause community acquired pneumonia, namely Strep pneumoniae, Hemophilus influenza (not the flu - which is a virus), Moraxella catarrhalis. These organisms are susceptible to Amoxicillin (1st line drug), and Augmentin (2nd line drug). Usual 7-10 day course is curative unless it's viral or a complicated, perforated infection of the middle ear.

I suspect you may have a middle ear infection which may have caused the glands around the ear to swell. When this happens, your adenoids and tonsils swell up. This could cause that lumpy sensation in the throat. Additionally, which any ear, sinus or mouth infection, mucus is produced and drains into the back of the throat. The throat is not used to the amount of mucus. As a result, it tries to clear it overproducing saliva. Sometimes the mucus can reach into the stomach and causing overproduction of acid, which can further aggravate the throat lump when lying down. The esophagus (the tube that carries food from the mouth to the stomach), can become spastic as a result and thus give you that lumpy sensation.

However, having all that said, you would need a proper physical exam.
My suggestion at this time, keep your ear dry. warm gargles with salt. PLenty of fluids to loosen up the phlegm. Keep your head of bed elevated. Avoid foods high in acidic contents.

Worrying will only produce more stress. Stress ulcers are related to hypersecretion of stomach acid in response to stress.

Keep me updated.

BISPHOSPHONATES ARE KNOW TO CAUSE EROSIVE ESOPHAGITIS ---> erosion of the esophagus.



Take this medication with plenty of water. Avoid lying down at least 2 hours before going to bed.

DocMaster wrote:

sam_bro wrote:

DocMaster wrote:

I am seeing that many are having issues with throat lump and back pain.  Let me demystify the symptoms.

The throat is nothing more than two tubes: the trachea which is the windpipe, the part that you can feel.  It has cartilage and is ringlike.  Behind that, is the esophagus, also known as the tube that allows food to pass into your stomach.  Behind that is your spinal cord (cervical).  Surrounding all of these are muscles and lastly, skin.  there are nerve fibers running within the muscles.  prominent ones can include nerves 10 (vagus) which controls heart rate, nerve 7 (controls motor function to the face/tongue and sensation to the tongue), nerve 11 (muscles for swallowing in the esophagus).  Nerve 11 also controls your shoulders and muscles that aid in raising or lowering your wing bones. 

Now let's get back to the throat lump.  There are several causes to the throat lump:

1. physiological - this part deals with nerves

2. mechanical - this part deals with muscles and anything else that causes obstruction

In the context of throat lump, one has to be specific:

1. Timing when it occurs.  If it comes and goes --> unlikely to be cancer.  If it stays, one has to ask, what are my risk factors???  Do you smoke, drink, oral sex (there is increasing evidence in head/neck cancer related to HPV).  HPV usually appears behind the tongue.  HPV is the same virus that causes warts.

2. symptoms.  does it cause pain?  does it cause hoarseness?  This means that the lump impinged on surrounding structures

3. Associations.  Does heat make it better?  Does ibuprofen, motrin or any other NSAIDs improve it??  This point towards inflammation.  Warm gargles with salt will improve inflammation because heat mobilizes the lump and the salt draws water out of the lump.  

4. Red flag symptoms: weight loss, pain with swallowing, vomiting of blood, going number 2 with blood.  These are worrisome signs and require further workup with endoscopy.

Causes:

1. acid reflux can cause many symptoms.  risk factors are: obesity, caffeine, chocolate, smoking, alcoholic, eating too much before bedtime.  Symptoms can include heartburn, chronic cough, hoarseness, asthma.  This is due to the inadequate closure of the lower esophageal sphincter that normally prevents acid from refluxing into the esophagus.  Thus when lying down, it refluxes into the throat.  If the reflux is high enough, it can cause reflux into the larynx (voice box) called Laryngopharyngeal reflux.  This can result in a throat lump sensation with hoarseness.  Chronic reflux can cause scarring and also cause a throat lump.  Treatment is anti-reflux therapy, weight loss, quit alcohol, eat small meals.

2. cricopharyngeal spasm: cause is not known but this is due to the muscles surrouding the adam's apple to constrict causing a choking sensation associated with nausea, and difficulty swallowing.  Although no real problems with eating or drinking.  This will go away...eventually.

3. Accessory nerve impingement: nerve 11 courses down the throat into the back to the wing  bone.  Impingment of this nerve will cause a throat lump with back pain.  Risk factors are trauma, stress, lifting objects, stiff neck.  There is usually a knot near the wing bone that is extremely painful on massage.  But massaging it will relieve the throat lump as well as the back pain.

4. Allergies: can cause lymph nodes to enlarge.  The lymph nodes are located on the sides of the esophagus.  When enlarged, can impinge and cause a throat lump.  Enlargement causes include: allergies, infections, cancer.

5. Bony disease: arthritis of the spine can cause a throat lump since the spine sits behind the esophagus.  Also misalignment of bones can cause the same.

6.  Infections: middle ear infections, throat infections, esophageal infection/inflammation can cause lymph node enlargements and thus throat lump.  you can get fevers here.

Workup:

the workup of throat lump, if symptomatic (causing swallowing difficulties), being with a swallow study called barium swallow.  here you swallow food with a tracer and multiple x rays are taken to see if there is mechanical obstruction.

If there is a mechanical obstruction, the next test is a EGD where a camera is placed into the throat to see what it is.  

If there is no mechanical obstruction, the next test is a manometry where electrodes are placed to check for nerve function.

Imaging studies are also good.  CT scans are very good.  MRI even better but much more costly.

Rx:

if due to acid reflux, try anti-reflux therapy

if due to infection, check for Strep throat, Infectious Mono - Dr will do a throat swab and start abx.

Allergies: antihistamine

If symptoms do not improve, seek professional care.

Again these are for educational purposes only.  I do not diagnose any disease or infer based on unfound physical examinations.

MasterDoc,

I'm 24 and 3 years ago i choked on a food, accidentally swallowed a plum seed with a click sound on the way down. Immediate X-rays showed the throat was normal. But the lodged globus feeling is still there to this day to the right side of my vocal chord. Since that day's fiasco, I had been having pharyngitis once every year. The tendency of swallowing twice and even thrice was always there, where I'd feel that the lump's moving. The ENT was insistent that it was all in my mind and it drove me nuts because i could swear something was there. Strangely, 2 weeks ago i got his weird fever which didn't show any flu-like symptoms, such as cold, or coughs, but a mild pharyngitis. So the ENT, thankfully, made me do a Laryngoscopy, a TSH and CBC test, and an ultra sonogram of my entire throat. The reports came normal again. However, two days later i found out that I am infected with Hepatitis-a and hence the fever. The ENT diagnosis was stalled hence.

But now with the routine resting period, i have got too much time to ponder over my throat discomfort for my liking, and the lump feeling has grown on me. The throat's mostly never felt relaxed over the last three years, apart from a few times where for a very very brief moment the lump dissappeared. It's gets worse as the day progresses, and gets me freaked out at night.
The glands under my chin are giving me occassional sharp pains and also behind my right ear. There's also some pain behind my right hyoid bone. Furthermore, at times, my neck above the right shoulder blade, closer to the spine,
gives off a pinchy throbs. I stopped smoking about a month ago in the hopes of making it go away. But my throat feels really irritated right now and i need to know what's causing this. Meawhile, I at times wake up from sleep with a dead arm and I do have a little bit of anxiety, I mean come on... it's only natural.

I've told you everything because I don't want to leave out any details should they prove to be important knowledge.

Could be because my vocal cord nerves got damaged when i choked?
Or do i have an ear infection as well as an anxiety related spasm?
Or is it much more serious than that?

would really appreciate your reply.

Sam

Hi Sam,

Throat lumps can be very tricky. May I ask how long you have smoked and much you have smoked? Are you engaged in any high risk oral sexual behaviors? Are you losing weight? Does the throat lump cause pain with swallowing?

What I am trying to understand is the red flag symptoms to throat lump which includes:

1. age > 55 y.o
2. unintentional weight loss
3. pain with swallowing
4. blood in the stool
5. spitting up of blood
etc ... etc...

These red flags are indicative of cancers although further testings are necessary.

Given your presentation, I highly doubt that vocal cords are damaged as can be seen from a laryngoscopy. If you have no problems talking, chances are your vocal cords are intact.

With the ear presentation, is there ear fullness behind the ear? Do you feel pressure? Ear infections can precipitate pharyngitis. The ear has a drainage tube called the Eustachian tube which acts to drain all the junk stuff from the middle ear. When it is clogged, bacteria builds up and cause a middle ear infection which can be present as: ear fullness, pressure, diminished hearing, pain and sometimes discharge, dizziness, ringing in the ear. To diagnose an ear infection, your ENT would need to look into your ear with an otoscope. The treatment is empiric. Middle ear infections are usually caused by the same organisms that cause community acquired pneumonia, namely Strep pneumoniae, Hemophilus influenza (not the flu - which is a virus), Moraxella catarrhalis. These organisms are susceptible to Amoxicillin (1st line drug), and Augmentin (2nd line drug). Usual 7-10 day course is curative unless it's viral or a complicated, perforated infection of the middle ear.

I suspect you may have a middle ear infection which may have caused the glands around the ear to swell. When this happens, your adenoids and tonsils swell up. This could cause that lumpy sensation in the throat. Additionally, which any ear, sinus or mouth infection, mucus is produced and drains into the back of the throat. The throat is not used to the amount of mucus. As a result, it tries to clear it overproducing saliva. Sometimes the mucus can reach into the stomach and causing overproduction of acid, which can further aggravate the throat lump when lying down. The esophagus (the tube that carries food from the mouth to the stomach), can become spastic as a result and thus give you that lumpy sensation.

However, having all that said, you would need a proper physical exam.
My suggestion at this time, keep your ear dry. warm gargles with salt. PLenty of fluids to loosen up the phlegm. Keep your head of bed elevated. Avoid foods high in acidic contents.

Worrying will only produce more stress. Stress ulcers are related to hypersecretion of stomach acid in response to stress.

Keep me updated.

Thanks for the reply DocMaster.

I have been smoking for exactly 4 years now, about 8 cigarettes a day.
There has been no high risk oral sexual behaviours from my part.
The lump doesn't cause any pain with swallowing but at times it feels like a poke and a sharp thing would tear through my adam's apple if swallowed with haste or force.

There are no other red flags consitent with what you've mentioned.

I forgot to mention before that the laryngoscopy report, in the oropharynx, showed that I have Hyperthrophied Lymphoid follicles in posterior tongue.

But the lump really feels like it's moving around. I mean my throat usually has a fair amount of mucus and i dont usualy clear it as it provides comfort while swallowing phlegm and also prevents the moving lump feeling, holding it up where it causes the least amount of problems, ie. around the hyoid bone. Whenever my ENT gave me Azithromycin, the throat always cleared up and the sharp pokes and the lump moving would resume and the sharp pokes feel further down the throat (as if the lump moved down with every swallow) and a pressing feeling around nerves of the throat right about the clavicles came into play and it caused pain even when i breath. Anyhow, the nerve above the right side of the vertebrae in my neck is in constant discomfort, forcing me to flex my head whenever it becomes beyond tolerable.

My right ear does have quite a bit of fullness. And it does tend to feel under pressure, and not to mention tinnitus. The glands behind it has swollen quite a bit now. This has been on and off for months now. Though it started feeling like this right after the choking incident. Furhtermore, the glands on the left of my throat have swollen in the last 3-4 days. And also... my Adams apple hurts upon touching and pressing the around the points where i get the sharp pokes from.

It would bring be a sort of a world of relief if what you just speculated turns out to be right. As I was once scheduled for a ear clean-up 6-7 years ago, but had to move out of town and later forgot about it because it didn't cause much of a trouble back then.

But doesn't a serious ear infection like the ones you've mentioned cause god-like unbearable pain in the inner ear and the Eustachian? I don't have anything like that atm. I know this because I used to get ear infections every winter during my early teens, and used to hurt like hell. But i do have my right ear heated from the inside, under the right of my jaw as well and a tingly feeling at the back of my mouth.

Thankfully now I'm 22 days into my jaundice incubation and hopefully have entered the recovery phase and may pay my ENT a visit within a week.

I'll keep you posted. Thank you very much for your keenness. Consulting with you is really helping me psychologically, if not directly.

Sam

Maybe Glossalphaylgial neuralgia

Maybe glossalpharyngeal neuralgia

Omg these are my symptoms now and I'm not sure if I should go to the ER. It hurts when I burp, swallow,bend down, and really bad when I sneeze. My left shoulder blade hurt so bad last night I wasn't sure if I could drive. I didn't sleep at all from the upper back pain. I wasn't sure if the back and throat pain were related but now I know it is.

yes, I was just diagnosed with throid low and put on syn throid,now I have pains in my back jaw,and felt like i was having a heart attack .it was sc ary..now i have this lump in my throat wont go away,no matter what i take for it. yes i also experienced wt. loss,vomiting headaches.after all the tests related nothing is resolved.

well what was the name of the book and where was the trigger point could use the info please

I get that, for me it's a hive.